Comparison of Ketamine-Dexmedetomidine and Ketamine-Propofol for procedural sedation in adults – A single-center prospective randomized control study

Background: Procedural sedation and analgesia (PSA) aims to reduce pain, stress, and anxiety of patients undergoing short procedures while maintaining spontaneous respiration. While ketamine, dexmedetomidine, and propofol are commonly used drugs for PSA, literature comparing combinations of these drugs shows conflicting results. Aims and Objectives: This study aims to compare the efficacy and hemodynamic profiles of ketamine-dexmedetomidine (KD) and ketamine-propofol (KP) in adult patients undergoing PSA. Materials and Methods: A prospective, randomized study was conducted on 60 adult patients who were assigned to receive either ketamine 1 mg/kg and dexmedetomidine 0.5 μg/kg (Ketodex or KD) or ketamine 1 mg/kg and propofol 2 mg/kg (Ketofol or KP). The primary outcome measure was recovery time following sedation. Secondary outcomes included sedation quality, hemodynamic stability, oxygen saturation, supplemental ketamine requirements, and post-operative pain control. Results: The distribution of physical characteristics was similar between the groups. The KD group had significantly higher sedation scores at 5 min (P=0.04), lower heart rates (P≤0.05), higher systolic (P<0.001 at 5 min, P=0.02 at 10 min) and diastolic blood pressures (P=0.02 at 5 min) compared to the KP group. SpO2 remained stable in both groups. Recovery was significantly faster in the KD group (1 min vs. 9 min, P<0.001). The KD group had better post-operative pain control, with lower Visual Analog Scale scores at multiple time points (P<0.05). Conclusion: The KD combination provides faster recovery, superior sedation quality, more favorable hemodynamic stability, and better post-operative pain control compared to KP combination in adult patients undergoing PSA.